caa a22 4500 605486565 CHVBK 20210128100446.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s00064-014-0330-3 doi (NATIONALLICENCE)springer-10.1007/s00064-014-0330-3 Impaction bone grafting for the reconstruction of large bone defects in revision knee arthroplasty [Elektronische Daten] [M. Rudert, B.M. Holzapfel, E. von Rottkay, D.E. Holzapfel, U. Noeth] Impaction-Bone-Grafting zur Rekonstruktion ausgedehnter Knochendefekte beim Knieprothesenwechsel Objective: Regeneration of autologous bone stock and formation of a stable implant bed by impaction of morselized bone allograft. Indications: Bone loss after septic and aseptic loosening or tumour resection. Contraindications: Persistent infection, one-stage septic revision, poor therapeutic compliance, extensive uncontained metaphyseal defects with cortical thinning of the diaphysis. Surgical technique: Whilst the surgeon removes the loose prosthesis, the assistant prepares the graft. The medullary canal is sealed with a cement restrictor. Graft particles of different sizes are densely impacted around a trial stem. The highest level of stability is achieved by using large particles interspersed with small filler particles. Low-viscosity cement facilitates cement penetration and ensures strong interdigitation with the impacted graft mass after implantation of the prosthesis. Uncontained metaphyseal defects are treated with prosthetic augments. Postoperative management: Gait training, physiotherapy with isometric quadriceps exercises, partial weight-bearing for 6weeks, resistance training begins 8weeks postoperatively. Results: Between 2010 and 2012, 28patients with large bone defects [Anderson Orthopaedic Research Institute (AORI) grade: 21 × F3, 3 × F2, 13 × T3, 8 × T2] underwent total knee revision with impaction bone grafting. The mean follow-up was 27.7months (range 21-47months). On average, patients had undergone 2.5previous revisions. Implant survival was 82.0 % (95 % CI = 62.5 %-92.1 %) for any reason of revision as the endpoint and 93.1 % (95 % CI = 74.5-98.4 %) for aseptic revision as the endpoint. The mean postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 35.4 (range 3.3-101.6, SD ± 26.2). The mean KSS was 70.6 (range 20-100, SD ± 26.8). Springer-Verlag Berlin Heidelberg, 2015 Bone defects nationallicence Impaction nationallicence Bone grafting nationallicence Allograft nationallicence Reconstruction nationallicence Knochendefekte nationallicence Impaktion nationallicence Knochentransplantation nationallicence Allotransplantat nationallicence Rekonstruktion nationallicence Rudert M. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut Holzapfel B.M. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut von Rottkay E. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut Holzapfel D.E. Department of Trauma Surgery, University Hospital Munich, Campus Innenstadt, Ludwig-Maximilians University, Munich, Germany aut Noeth U. Department for Orthopaedics and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany aut Operative Orthopädie und Traumatologie Springer Berlin Heidelberg 27/1(2015-02-01), 35-46 0934-6694 27:1<35 2015 27 64 https://doi.org/10.1007/s00064-014-0330-3 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00064-014-0330-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Rudert M. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut NATIONALLICENCE 700 1- Holzapfel B.M. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut NATIONALLICENCE 700 1- von Rottkay E. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany aut NATIONALLICENCE 700 1- Holzapfel D.E. Department of Trauma Surgery, University Hospital Munich, Campus Innenstadt, Ludwig-Maximilians University, Munich, Germany aut NATIONALLICENCE 700 1- Noeth U. Department for Orthopaedics and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany aut NATIONALLICENCE 773 0- Operative Orthopädie und Traumatologie Springer Berlin Heidelberg 27/1(2015-02-01), 35-46 0934-6694 27:1<35 2015 27 64